health insurance

tistan

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Does anyone have a health insurance plan that lets you control where you go to get care? The last two times I needed to get care, I could have gone to the orthopedic center and had my surgery done with less headache and at a much lower cost. Insurance wouldn't pay for their care facility and made me go to the hospital. My $5k surgery at the center gets bumped to $25k at the hospital and my $15k surgery got bumped to $50k at the hospital. I get hit with 20% co pay and end up paying for the entire surgery anyway. I'm probably going to completely drop insurance and pay out of pocket and If I have catastrophic illness I'll bankrupt. I'm sure there is a way to move all assets into some kind of secured trust or overseas accounts.
 

Logan2003Cobra

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There are several items to consider when purchasing and using a health insurance plan. Out of Pocket, Out of Pocket Max, In-Network, Out of Network, Co-Insurance, Co-Pay, etc. Your larger insurance providers (UHC, Cigna, Aetna, etc.) usually have a large network with plenty of Primary Care Providers, Hospitals, & Specialists in the network. Also, the more expensive the plan (monthly premiums) the lower the deductibles, co-pays, & out of pocket maximums are.

Use the following high deductible plan as a generic example:

Deductible Amounts Individual/Family
* In-Network $5,000/$10,000
* Maximum out of Pocket In-Network $7,500/$15,000
** Out of Network $7,500/$15,000
** Maximum out of Pocket Out of Network $15,000/$30,000
Co-Insurance Once Deductible Met (co-pay)
* In-Network 20% Until Max Reached
** Out of Network 50% Until Max Reached

Scenario 1
You go to your primary care physician, need tests run, need surgery, and EVERYTHING is done In-Network... your worst case max out of pocket in this situation would be $7,500.

Scenario 2
You go to your primary care physician, need tests run, need surgery, and everything is done In-Network EXCEPT the anesthesiologist who is Out of Network and their cost is $10,000... your worst case max out of pocket in this situation would be $12,500.

Note: if both In-Network and Out of Network charges and co-pays were to be maxed out, the total Out of Pocket would not be higher than $22,500.

This is where supplemental insurance (like Aflac) can help as they would simply cut you a check depending on what you have coverage for. Granted, this might only be for a couple thousand dollars but every little bit helps when you have a major accident and/or need surgery.
 
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SHOdown220

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Healthcare is over complicated and insanely over priced for a lot of their services. Our son needed to go to a children’s hospital shortly after he was born. I won’t go into detail (he’s fine) but since he hadn’t been discharged yet from the hospital he was born they wouldn’t let us drive him to the children’s hospital 25 miles away, they said they had to transport him there just in case. Ok I get that. We got the insurance papers the other day explaining charges. $6,400 in transport charges , plus $14,500 for 1 night in NCIU.
 

Blk04L

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I've had no issue with Blue Cross PPO option I have at work.

Their network at least around me is fairly large.
 

tistan

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Healthcare is over complicated and insanely over priced for a lot of their services. Our son needed to go to a children’s hospital shortly after he was born. I won’t go into detail (he’s fine) but since he hadn’t been discharged yet from the hospital he was born they wouldn’t let us drive him to the children’s hospital 25 miles away, they said they had to transport him there just in case. Ok I get that. We got the insurance papers the other day explaining charges. $6,400 in transport charges , plus $14,500 for 1 night in NCIU.
If you were not insured and were paying out of pocket, those prices would be a quarter of that. Reason I know is that the last two surgeries I needed, the insurance, doctors, and the hospital couldn't get their shit together. I had them run me a out of pocket. If I would have payed out of pocket at either the hospital or the orthopedic facility, my operation cost would have been $3k at hospital or $5k at the ortho facility. By going through insurance, since they jack up the pricing, I'm actually paying $6k for a procedure that would have cost $3k. I find insurance to be such a scam that I am also considering self insuring. I'm going to figure out if I can set up a trust to protect my assets and then If I get a major medical, then I will bankrupt on everyone.
 

SHOdown220

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If you were not insured and were paying out of pocket, those prices would be a quarter of that. Reason I know is that the last two surgeries I needed, the insurance, doctors, and the hospital couldn't get their shit together. I had them run me a out of pocket. If I would have payed out of pocket at either the hospital or the orthopedic facility, my operation cost would have been $3k at hospital or $5k at the ortho facility. By going through insurance, since they jack up the pricing, I'm actually paying $6k for a procedure that would have cost $3k. I find insurance to be such a scam that I am also considering self insuring. I'm going to figure out if I can set up a trust to protect my assets and then If I get a major medical, then I will bankrupt on everyone.

Yeah I guess that was the point I was trying to get at before I went off into a rant lol. It should just be a set price but if insurance is paying they are like oh well we can just upcharge this and that and they'll pay it. In turn insurance rates just keep going up to offset the b.s. increased cost. My wife ordered a breast pump a few months ago through insurance because it was covered under her plan. When she received it, it had the invoice inside for something like $950, looked up that exact same pump to purchase at the store for under 300 bucks. So they more than tripled the cost when billing to insurance.
 

tistan

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Yeah I guess that was the point I was trying to get at before I went off into a rant lol. It should just be a set price but if insurance is paying they are like oh well we can just upcharge this and that and they'll pay it. In turn insurance rates just keep going up to offset the b.s. increased cost. My wife ordered a breast pump a few months ago through insurance because it was covered under her plan. When she received it, it had the invoice inside for something like $950, looked up that exact same pump to purchase at the store for under 300 bucks. So they more than tripled the cost when billing to insurance.
One of my clients is a medical device sales rep. before I knew him he was actually at my broken collar bone surgery and provided the titanium piece for the repair. That piece of titanium was $15k to the insurance. I asked him how much does that really cost, about $1k.
 

kirks5oh

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Switch insurers. Plain and simple. Don’t pay out of pocket. If you have a complication or readmission to the hospital, your $6k bill becomes $100k.
 

BrunotheBoxer

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Not for nutin but. It’s almost like the hospitals the doctors big pharma and the insurance companies are in some kind of cahoots together?

We once had a president that tried to fix all this but he sent out a mean tweet so some other people decided that wasn’t good for America or the people and fixed all that.

Now imagine if big pharma got with insurance companies and the government and tried to force healthy people to take medicine for “free” against a illness with a 99.8% survival rate.
Then I bet people would get really really mad.
 

tistan

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Switch insurers. Plain and simple. Don’t pay out of pocket. If you have a complication or readmission to the hospital, your $6k bill becomes $100k.
If I had all my assets in protection, I would just bankrupt.
 

lOOKnGO

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365 Saleen

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I just have a Health Savings Account. No Insurance plan. I have been healthy my entire life. I wish I could have back the $ spent in previous years on health Insurance. I could be retired already.
Yes it is possible to have a catastrophic medical event that could bankrupt me, but I could also get struck by lightning, or better yet hit a Moose on the way into work tomorrow.
I am not going to live in a cave in fear of what "might" happen.
The only time I have needed medical care was covered by L&I or Workers Comp for a work related injury. Oh, and that time some dumb girl hit me with her car while I was riding by bicycle home from work. None of those cases required my health Insurance to be used.
I pay out of pocket for contact lenses and any dental work. Insurance for those rarely covers 50% of costs anyway.
 

cobracide

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Had a CT Scan w/contrast done recently. $75K billable to insurance. Yeah right. Jack it up. No wonder insurance is a fortune with huge deductibles. Probably 5k in mexico for the same thing.
 

tistan

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I just have a Health Savings Account. No Insurance plan. I have been healthy my entire life. I wish I could have back the $ spent in previous years on health Insurance. I could be retired already.
Yes it is possible to have a catastrophic medical event that could bankrupt me, but I could also get struck by lightning, or better yet hit a Moose on the way into work tomorrow.
I am not going to live in a cave in fear of what "might" happen.
The only time I have needed medical care was covered by L&I or Workers Comp for a work related injury. Oh, and that time some dumb girl hit me with her car while I was riding by bicycle home from work. None of those cases required my health Insurance to be used.
I pay out of pocket for contact lenses and any dental work. Insurance for those rarely covers 50% of costs anyway.
I have been considering going health savings account.

What does this mean? Are you forced to have insurance to qualify for the HSA?
"You can only open and contribute to a HSA if you have a qualifying high-deductible health plan."
 

Logan2003Cobra

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I have been considering going health savings account.

What does this mean? Are you forced to have insurance to qualify for the HSA?
"You can only open and contribute to a HSA if you have a qualifying high-deductible health plan."
Yes, the HDHP is the qualifier for an HSA.
 

365 Saleen

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I have been considering going health savings account.

What does this mean? Are you forced to have insurance to qualify for the HSA?
"You can only open and contribute to a HSA if you have a qualifying high-deductible health plan."
Might depend on which State you live in. I was allowed to just have a HSA. I don't have any other Health Insurance. My pay stub shows my HSA contribution. There is no deduction for Health Insurance. My employer also contributes to the HSA. I am limited on how much per year can be contributed to the HSA, which at this time has a maximum of $58 and change per week. The Employer contributes just over $800 per year.
 

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